Diet, Health, Fitness, Lifestyle & Wellness

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How can boosting bacteria in your body improve your brain health? Called the “second brain” by leading scientists, a healthy balance of flora in the gut helps to determine whether you’ll have a great memory and a strong resistance to brain disease.

And what happens in the gut plays a significant role in your brain health. Restoring beneficial bacteria and some healthy yeasts in your intestines (yes, some yeasts are beneficial, just not the ones that cause yeast infections) can go a long way toward protecting your mental faculties and preventing brain diseases altogether.

Frequently when I tell people about this connection between intestinal and brain health—what is known as the gut-brain axis, they tell me that they are covered because they eat yogurt on a regular basis. While yogurt may (or may not) help boost intestinal flora depending on whether it contains any live cultures at all, we need to give our guts a lot more than yogurt to help us establish a strong and healthy brain for life.

Let’s explore some of the exciting research into the link between beneficial microbes in our gut and our overall brain health.

Some probiotics actually function as antioxidants within the body, which can not only reduce the effects of free radical damage and aging, it is especially good news in the prevention and treatment of brain diseases.

That’s because the brain is vulnerable to free radical damage. Additionally, research at the University of California at Los Angeles (UCLA) found that consuming certain strains of probiotics could actually produce many brain health benefits, including improved sensory and emotional processing.

Since the brain plays a significant role in whether we suffer from mental health conditions like anxiety and depression, probiotics may also be helpful in addressing these serious health concerns. In animal studies conducted by the Department of Medicine at McMaster University, Hamilton, Ontario, Canada, and published in the medical journal Gastroenterology, the probiotic Bifidobacterium longum eliminated anxiety and normalized behavior. It appeared to work by reducing the excitability of the nerves in the gut that connect through the vagus nerve to the central nervous system, and in doing so, eliminated anxiety.

Hungarian researchers found that intestinal inflammation is one of the key factors involved in depression and that treating the inflammation with probiotics (along with B complex vitamins, vitamin D, and omega 3 fatty acids) reduced depressive symptoms.

Additional French research demonstrates the power of boosting specific strains of probiotics to boost mood and psychological health. They found that healthy study participants experienced reduced psychological stress, depression, anxiety, and anger and hostility, as well as improved problem-solving skills when taking the Lactobacillus helveticus and Bifidobacterium longum for 30 days.

While you can still enjoy yogurt if you are already doing so, please keep in mind that the above strains are not typically found in yogurt. I’m not aware of any yogurt that contains the best brain-boosting strains.

Take a probiotic supplement containing proven strains of brain-boosting probiotics such as Lactobacillus plantarum, Bifidobacterium longum, and Lactobacillus helveticus on a daily basis. Store your probiotics in the refrigerator, and take them on an empty stomach. First thing in the morning with a large glass of water tends to work well for most people.

Additionally, kimchi—the national dish of Korea which is typically a fermented mixture of cabbage, chilis, and garlic—frequently contains a much more diverse group of beneficial microbes than yogurt, making it an excellent choice as a brain boosting food. Some types contain fish sauce so if you’re vegan be sure to choose a fish sauce-free option. It is delicious on sandwiches, over brown rice, or as a side-dish to many foods. Be sure to choose kimchi that hasn’t been pasteurized to ensure the cultures are still intact.

We North Americans do love our dietary supplements. More than half of the adult population have taken them to stay healthy, lose weight, gain an edge in sports or in the bedroom, and avoid using prescription drugs. In 2009, we spent $26.7 billion on them, according to the Nutrition Business Journal, a trade publication.

What consumers might not realize, though, is that supplement manufacturers routinely, and legally, sell their products without first having to demonstrate that they are safe and effective. The Food and Drug Administration has not made full use of even the meager authority granted it by the industry-friendly 1994 Dietary Supplement Health and Education Act (DSHEA).

As a result, the supplement marketplace is not as safe as it should be.

We have identified a dozen supplement ingredients that we think consumers should avoid because of health risks, including cardiovascular, liver, and kidney problems. We found products with those ingredients readily available in stores and online.

Because of inadequate quality control and inspection, supplements contaminated with heavy metals, pesticides, or prescription drugs have been sold to unsuspecting consumers. And FDA rules covering manufacturing quality don’t apply to the companies that supply herbs, vitamins, and other raw ingredients.

China, which has repeatedly been caught exporting contaminated products, is a major supplier of raw supplement ingredients. The FDA has yet to inspect a single factory there.

The lack of oversight leaves consumers like John Coolidge, 55, of Signal Mountain, Tenn., vulnerable. He started taking a supplement called Total Body Formula to improve his general health. But instead, he says, beginning in February 2008, he experienced one symptom after another: diarrhea, joint pain, hair loss, lung problems, and fingernails and toenails that fell off. “It just tore me up,” he said.

Eventually, hundreds of other reports of adverse reactions to the product came to the attention of the FDA, which inspected the manufacturer’s facilities and tested the contents of the products. Most of the samples contained more than 200 times the labeled amount of selenium and up to 17 times the recommended intake of chromium, according to the FDA.

In March 2008 the distributor voluntarily recalled the products involved. Coolidge is suing multiple companies for compensatory damages; they have denied the claims in court papers. His nails and hair have grown back, but he said he still suffers from serious breathing problems.

The dirty dozen

Working with experts from the Natural Medicines Comprehensive Database, an independent research group, we identified a group of ingredients (out of nearly 1,100 in the database) linked to serious adverse events by clinical research or case reports. To come up with our dozen finalists, we also considered factors such as whether the ingredients were effective for their purported uses and how readily available they were to consumers. We then shopped for them online and in stores near our Yonkers, N.Y., headquarters and easily found all of them for sale in June 2010.

The dozen are aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe. The FDA has warned about at least eight of them, some as long ago as 1993.

Why are they still for sale? Two national retailers we contacted about specific supplements said they carried them because the FDA has not banned them. The agency has “the authority to immediately remove them from the market, and we would follow the FDA recommendation,” said a spokeswoman for the Vitamin Shoppe chain.

Most of the products we bought had warning labels, but not all did. A bottle of silver we purchased was labeled “perfectly safe,” with an asterisked note that said the FDA had not evaluated the claim. In fact, the FDA issued a consumer advisory about silver (including colloidal silver) in 2009, with good reason: Sold for its supposed immune system “support,” it can permanently turn skin bluish-gray.

Janis Dowd, 56, of Bartlesville, Okla., says she started taking colloidal silver in 2000 after reading online that it would keep her Lyme disease from returning. She says her skin changed color so gradually that she didn’t notice, but others did. “They kept saying, ‘You look a little blue.'”

Laser treatments have erased almost all the discoloration from Dowd’s face and neck, but she said it’s not feasible to treat the rest of her body.

Under the Dietary Supplement Health and Education Act (DSHEA), it is difficult for the FDA to put together strong enough evidence to order products off the market. To date, it has banned only one ingredient, ephedrine alkaloids. That effort dragged on for a decade, during which ephedra weight-loss products were implicated in thousands of adverse events, including deaths. Instead of attempting any more outright bans, the agency issued warnings, detained imported products, and asked companies to recall products it considered unsafe.

No scientific backup required

Of the more than 54,000 dietary supplement products in the Natural Medicines Comprehensive Database, only about a third have some level of safety and effectiveness that is supported by scientific evidence, according to a review by NMCD experts. And close to 12 percent have been linked to safety concerns or problems with product quality.

Consider the path to market of Go Away Gray, a product that is claimed to “help stop your hair from turning gray.” Cathy Beggan, president of the supplement’s maker, Rise-N-Shine, based in New Jersey, said that her company has not had to provide product information to the FDA. Nor did it conduct any clinical trials of the supplement, which includes a natural enzyme called catalase, before putting it on sale. Beggan pointed us to a study by European researchers published in the July 2009 issue of the Federation of American Societies for Experimental Biology Journal. The study found that gray hair had lower-than-normal levels of catalase but did not prove that taking that enzyme by mouth would stop hair from turning gray. “We are working on getting an actual clinical trial going because the results have been so amazing, and it would just be good to have some concrete data behind it,” Beggan said.

Consumers in the dark about dangers

In March 2008, Marques Parke, 29, a plumber from Janesville, Wis., took a weight-loss supplement called Hydroxycut because he wanted to lose 5 pounds, he said. Within weeks he was stricken with acute hepatitis and jaundice. He is suing the manufacturer and others. An attorney representing the defendants said they intended to contest the claims.

The FDA had received its first adverse-event report about Hydroxycut in 2002, long before Parke started taking it. In May 2009, by which point Parke’s liver was already damaged, the agency warned consumers to stop using Hydroxycut, and the manufacturer, Iovate Health Sciences, voluntarily recalled some of its products, its attorney said.

The company had frequently reformulated the product, according to the FDA, which said it didn’t know which ingredients produced the liver toxicity. The FDA said that Hydroxycut presented “a severe, potentially life-threatening hazard to some users” and had been linked to two reported deaths. Hydroxycut has been reformulated and is on the market again. An FDA representative told us the agency considers the new version acceptable.

Amazingly, for the first 13 years after the enactment of the Dietary Supplement Health and Education Act (DSHEA), supplement makers didn’t have to inform the FDA if they received reports of serious adverse events, an obligation that’s required for prescription drugs. A law that took effect in December 2007 closed that loophole, and in 2008 and 2009 the FDA said it received 1,359 reports of serious adverse effects from manufacturers and 602 from consumers and health professionals. But even with the new law, consumers can’t easily find out which products are involved because the FDA doesn’t routinely make those reports available to the public.

Exaggerated claims

It’s against the law for companies to claim that any supplement can prevent, treat, or cure any disease except some nutrient-deficiency conditions. But in the past two years, the Federal Trade Commission has filed or settled 30 cases against supplement marketers, charging that they made exactly those kinds of claims. It reached a $7.5 million settlement with the QVC home-shopping channel. And the FDA has recently taken legal action against a few supplement manufacturers that claimed their products could prevent or treat a disease.

Undercover investigators from the Government Accountability Office, posing as elderly consumers, caught salespeople on tape dispensing potentially harmful medical advice. In one case, a salesperson told an investigator that a garlic supplement could be taken in lieu of high blood pressure medicine.

What you can do

The FDA and Congress have recently taken some action to strengthen the agency’s oversight, such as passing a law requiring that companies report serious adverse events. But much more needs to be done to keep consumers safe. In the meantime, here are steps you can take to make sure the supplements you use are safe and beneficial.

Consult your doctor or pharmacist. Even helpful products can be harmful in some situations, such as when you’re pregnant or nursing, have a chronic disease, or are about to have elective surgery. And some supplements might be fine on their own but interact with certain prescription drugs. Your doctor or pharmacist can steer you away from such problems only if they know what supplements you’re taking or plan to take.

Beware of these categories. Supplements for weight loss, sexual enhancement, and bodybuilding have been problematic, the FDA said, because some contain steroids and prescription drugs. Lose weight through diet and exercise, get fit through training, and consult your doctor if you need help in the bedroom.

Look for the “USP Verified” mark. It indicates that the supplement manufacturer has voluntarily asked U.S. Pharmacopeia, a trusted nonprofit, private standards-setting authority, to verify the quality, purity, and potency of its raw ingredients or finished products. USP maintains a list of verified products on its website.

Don’t assume more is better. It’s possible to overdose even on beneficial vitamins and minerals. Avoid any product that is claimed to contain “megadoses.”

Report problems. Let your doctor know if you experience any symptoms after you start taking a supplement. And if you end up with a serious side effect, ask your doctor or pharmacist to report it to the FDA, or do it yourself at http://www.fda.gov/medwatch or by calling 800-332-1088.

Research in the right places. Be skeptical about claims made for supplements in ads, on TV, and by sales staff. If a claim sounds too good to be true, it probably is. Instead, try these sources:

Your ‘all natural’ supplement might contain drugs

Consumers might be attracted to dietary supplements because they’re “all natural” and don’t contain the synthetic chemicals found in prescription drugs. But they might be getting fooled.

In the past two years, according to the Food and Drug Administration, manufacturers have voluntarily recalled more than 80 bodybuilding supplements that contained synthetic steroids or steroid-like substances, 50 sexual-enhancement products that contained sildenafil (Viagra) or other erectile-dysfunction drugs, and 40 weight-loss supplements containing sibutramine (Meridia) and other drugs.

Unwitting purchasers

“We’re talking about very serious risks and injuries that can happen to people—and often young people—who do not understand that they’re taking prescription drugs and steroids,” Joshua M. Sharfstein, M.D., the FDA’s principal deputy commissioner, told the U.S. Senate’s special committee on aging in May 2010.

In 2005, eager to make the most of his baseball scholarship at Lincoln University in Jefferson City, Mo., Jareem Gunter started taking a supplement he found online that promised to improve his athletic performance and claimed to be “legal,” he recalls. But he soon began feeling fatigued, and when the whites of his eyes turned yellow, he said, he went to the hospital. “I woke up in the morning and the doctor was sitting by my bedside,” Gunter said. “He told me, ‘Your liver’s failed. You only had a couple of days left to live if you hadn’t come in.'” The supplement turned out to contain a synthetic steroid, which cost Gunter his scholarship, he claimed in a lawsuit that was settled before the trial date, according to public court documents. He’s now 27 and living in Oakland, Calif. His health is much improved and he is working for a charitable organization and playing baseball in his hometown league.

Use with caution

Hazardous ingredients have been known to turn up in dietary supplements marketed for weight loss, bodybuilding, and sexual enhancement. And in light of the potentially serious health risks—including dangerous changes in blood pressure, serious liver injury, kidney failure, heart attack, and stroke—we think consumers should be extremely cautious with those categories of products or avoid them.

12 supplements you should avoid

These supplement ingredients are among those linked by clinical research or case reports to serious side effects. We worked with the Natural Medicines Comprehensive Database, an independent research group that evaluates the safety and effectiveness of nutritional supplements, to develop this list. We think it’s wise to avoid all the ingredients on it. Unless otherwise noted, there’s insufficient evidence to rate their effectiveness for their purported uses. Dangers listed are not meant to be all-inclusive.

11 supplements to consider

These popular supplements, listed in alphabetical order, have been shown to likely be safe for most people and possibly or likely to be effective in appropriate doses for certain conditions. Talk to your doctor or pharmacist before starting any supplement. Most supplements haven’t been studied in pregnant or nursing women. The list of interactions and side effects is not all-inclusive.

Name
(also known as)

Efficacy for selected uses

Selected potential side effects

Selected drug interactions

CALCIUM
(calcium carbonate, calcium citrate, calcium gluconate)

Likely effective in combination with vitamin D in preventing and treating bone loss and osteoporosis. Taken daily, appears to reduce some PMS symptoms.

Belching, gas.

Calcium can decrease the effectiveness of certain antibiotics, osteoporosis drugs, and thyroid drugs.

CRANBERRY
(American cranberry, large cranberry, cranberry extract)

Possibly effective for preventing recurrent urinary-tract infections.

Large amounts can cause stomach upset, diarrhea.

Might increase the effects of the blood thinner warfarin.

FISH OIL
(EPA/DHA, omega-3 fatty acids, PUFA)

Effective for reducing triglyceride levels. Likely effective for decreasing the risk of heart attack, stroke, and progression of hardening of the arteries in people with existing heart disease.

Fishy aftertaste, upset stomach, nausea, loose stools. High doses can increase levels of LDL (bad) cholesterol in some people or increase the chance of bleeding.

Might increase the effect of blood-thinning drugs and high blood pressure medications.

Likely effective in reducing symptoms of major depression, reducing pain, and improving functioning in people with osteoarthritis.

GI symptoms, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, and nervousness, especially at higher doses. It can make some people with depression feel anxious.

Might lead to a toxic reaction when taken with the cough suppressant dextromethorphan, certain antidepressants, or narcotic pain relievers. Might worsen symptoms when taken with the Parkinson’s drug levodopa.

ST. JOHN’S WORT
(Hypericum perforatum, Saynt Johannes Wort, SJW)

Likely effective for improving symptoms of some forms of depression.

Insomnia, vivid dreams, anxiety, dizziness, headache, skin rash, and tingling. It can cause skin to become extra-sensitive to the sun.

Can decrease the effectiveness of a wide range of drugs, including birth-control pills, heart medications, HIV/AIDS drugs, and warfarin. Might also increase the effects or side effects of certain antidepressants.

VITAMIN D
(Cholecalciferol, vitamin D3, ergocalciferol, vitamin D2)

Likely effective when taken with calcium to help prevent osteoporosis. Might help reduce falls in people with vitamin D deficiency and bone loss in people taking corticosteroids.

Extremely large amounts might cause weakness, fatigue, headache, and nausea, though side effects are rare.

Might reduce the effectiveness of some medications, such as atorvastatin (Lipitor), other heart medications, birth-control pills, HIV/AIDS drugs.

Like this:

The supplement starts to take effect after only two weeks, the researchers found.

Over-the-counter magnesium is a safe and effective way to treat mild to moderate depression, a new study suggests.

The mineral magnesium has already been linked to lower inflammation and improvements in depression.

Now a new randomised controlled trial has tested the effects of magnesium chloride supplements compared with no treatment.

For the research, half of 126 people with mild to moderate depression were given 248 mg of magnesium chloride per day for six weeks.

After just two weeks, some positive effects of the supplement could be seen.

Those taking magnesium had clinically significant improvements over the six weeks.

People did not have any problems taking magnesium and there were no differences based on sex, age, whether people were also taking antidepressants, or other factors.

More than half of the people in the study said they would continue to take magnesium to help them with their depression.

Ms Emily Tarleton, the study’s first author, said:

“This is the first randomized clinical trial looking at the effect of magnesium supplementation on symptoms of depression in U.S. adults.
The results are very encouraging, given the great need for additional treatment options for depression, and our finding that magnesium supplementation provides a safe, fast and inexpensive approach to controlling depressive symptoms.”

Ms Tarleton says that the next stage is to move on to larger populations to see if the results can be replicated.

While many more studies have investigated antidepressant medications, there is also much evidence of their side-effects.

A survey of people taking antidepressants has found higher than expected levels of emotional numbness, sexual problems and even suicidal thoughts associated with the medication.

Of the 20 adverse effects to antidepressants that people were questioned about:

Calcium and vitamin D may get the spotlight when it comes to bone health, but there’s another mineral that plays a role in keeping your skeleton strong: It’s magnesium, and 67% of the body’s stores for this mineral are found in your bones. Now, research published in the European Journal of Epidemiology suggests magnesium could help prevent fractures.

While previous research had revealed that magnesium supports bone growth, no study had tied the mineral to risk of bone fractures. Tapping into over 20 years of data on 2,245 men, investigators in Britain and Finland compared the men’s magnesium blood levels to their risk of fracture. They discovered that the higher a man’s magnesium, the lower his risk of fracture.

So, how much magnesium should you eat? The recommended daily intake for adults over 31 years of age is 320 mg for females and 420 mg for males. Nuts and seeds, especially almonds, sunflower seeds, walnuts and cashews are rich in magnesium. Other food sources include oatmeal, milk, peanut butter, spinach, broccoli, peas and beets.

However, the Finnish study couldn’t link dietary intake of magnesium to higher blood levels of magnesium, which is strange. Although the study authors aren’t sure why food couldn’t boost levels, previous research suggests an improvement in bone density among menopausal women who took supplements of magnesium hydroxide.

The bottom line is that eating foods high in magnesium still makes sense, since those foods tend to be healthy. If you’re at elevated risk for osteoporosis or fracture talk to your physician or a registered dietitian about taking magnesium supplements.

Magnesium deficiency is one of the most underrated minerals, but it’s involved in literally hundreds of your body’s functions. Pay attention to it, and your body will thank you.

So what’s the deal with magnesium?

Magnesium is involved in numerous bodily functions, from relaxing sore muscles to relieving anxiety, though it isn’t as widely discussed as other vitamins and minerals. Holistic nutrition coach Andrea Moss of Moss Wellness in New York City says magnesium deficiencies are such a big focus in her practice because nutritionists see the effects so frequently. “So many clients of ours are surprised to hear about it, since it usually isn’t discussed by their physicians,” she says. Don’t let that happen to you—check out our tips for what magnesium deficiency signs you might be ignoring.

You kind of hate vegetables

The most common cause of magnesium deficiencies is a diet deprived of magnesium-rich foods. “Many of us are magnesium deficient because we aren’t necessarily eating enough magnesium-rich foods,” says Moss. Moss recommends veggies, brown rice, nuts and seeds to adjust this.

You’re so stressed out

If you’re under a lot of stress, your body will react chemically and magnesium levels can be affected. “Stress also can make us more prone to magnesium deficiency, as can excessive sweating from workouts,” says Moss. Try to take it easy, both mentally and physically, and your body will thank you.

Junk food is one of your food groups

Replacing fruit with Fruit Roll-Ups can wreak havoc on your magnesium levels. “Normal, healthy people should get enough magnesium as long as they eat enough fruit, vegetables, and complex starches/whole grains,” says Monica Auslander, MS, RD, LD/N, founder of Essence Nutrition in Florida. “You can see how a poor diet quality could result in these deficiencies!” These are good clues you’re eating too many preservatives.

The littlest things can give you a headache

If your head is pounding and you can’t seem to shake it, you might want to get tested for a magnesium deficiency. People often have headaches when their magnesium levels are low, says Auslander.

You’re constipated

You might not think about magnesium levels when you’re constipated, but you should. Auslander says people often experience constipation precisely when their magnesium levels are too low.

You’re more shaky or twitchy lately

A little shake here or there might not seem like a big deal, but take it seriously. Nutritionist Alyse Levine MS, RD of Nutritionbite in California warns that chronically low levels of magnesium can lead to more serious problems like an irregular heartbeat or even seizures. It’s also a good idea to be aware of these other symptoms of atrial fibrillation.

Your energy levels are MIA

Magnesium helps energize your body, so if you don’t have enough of it, you’ll feel weak. “Magnesium is involved in at least 300 different chemical reactions in our body, and a lot have to do with energy production,” says Alison Boden, MPH, RD, functional medicine nutritionist in California. “A sign of low magnesium can be low energy.”

You’re not sleeping well

While magnesium can be used to treat a number of medical issues, and Boden uses it the most for sleep problems. “If patients have a hard time winding down, we use magnesium therapeutically to help with that,” says Boden. “It’s a muscle relaxant that can slow things down bit and help with sleep.”

You’re dealing with bone loss problems

A lot of magnesium is stored in bones, so Boden says a deficiency in it can cause bone loss when there isn’t enough magnesium over a long period of time.

You have low levels of vitamin D

When low magnesium levels lead to low vitamin D levels, a whole cascade of problems develop. “We need magnesium to absorb vitamin D. Too much calcium can actually lower absorption as well, so we need to find a balance between all these vitamins and minerals,” says Manuel Villacorta MS, registered dietitian and founder of Whole Body Reboot in California. “This stuff can happen to everyone.”

Taking extra vitamin D can protect against colds, flu and other respiratory infections, said a study Thursday which reopened a debate on the usefulness of over-the-counter supplements.

A review of 25 clinical trials in 14 countries, some with conflicting results, yielded “the first definitive evidence” of a link between vitamin D and flu prevention, researchers claimed in The BMJ medical journal.

The effects were strongest for people with very low levels of the nutrient which is found in some foods and can be synthesised by the body when the skin is exposed to ultraviolet light.

Many people, especially in grey, cloudy climes, do not have enough vitamin D.

Scientific studies over the years have delivered contradictory conclusions on the topic.

Some have shown that low levels of the vitamin increase the risk of bone fractures, heart disease, colorectal cancer, diabetes, depression, Alzheimer’s disease and death.

Others said there is no evidence of a link to disease risk.

For the new study, researchers from the Queen Mary University of London conducted the biggest-ever survey of trials involving nearly 11,000 people.

Vitamin D is found in some foods and can be synthesized
by the body when the skin is exposed to ultraviolet light.

And they found clues as to why supplements seem to work in some trials but not in others.

“The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely-spaced doses,” lead researcher Adrian Martineau said in a statement.

‘Undeniable’

Vitamin D is thought to protect against respiratory infections, including bronchitis and pneumonia, by boosting levels of antibiotic-like peptides in the lungs, said the team.

This fits with an observation that colds and flu are more common in winter and spring, when vitamin D levels are lowest.

It may also explain why vitamin D seems to protect against asthma attacks, they said.

In an editorial published with the study, experts Mark Bolland and Alison Avenell said it should be viewed as a hypothesis in need of scientific confirmation.

Louis Levy, head of nutrition science at Public Health England, shared their caution.

“This study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections,” he said via the Science Media Centre in London.

Other observers were more optimistic.

The case for universal vitamin D supplements, or food fortification, “is now undeniable,” concluded Benjamin Jacobs of the Royal National Orthopaedic Hospital.

We polled family doctors from across the country, and they laid down the law on eight things they wish we’d do—or stop doing.

According to our panel of general practitioners, Canadians aren’t always doing what they should to make the most of doctor visits—and skipping out on these crucial tactics could lead to a delay in diagnosing serious conditions. Here’s what our experts say you should add to your patient checklist.

1. Stop feeling shy

Many of us hesitate to talk to our physicians about sensitive issues (think substance abuse or sexual health—or even gender identity). But honesty and openness are important, both for fostering a good doctor-patient relationship and for ensuring that you get the best care, says Dr. Laura Pripstein, medical director of the Sherbourne Health Centre in Toronto and a staff physician on the family health team. That’s why it’s OK to try out a doc before committing. Dr. Pripstein recommends booking an initial visit to see if your potential doctor is a good fit. “You want to see if this person seems like someone you can talk to, someone you feel comfortable with,” she says. And if you don’t think your doctor understands or respects your concerns, don’t be afraid to find someone new. “If you feel you can’t ask questions that might be embarrassing, you don’t have the right provider,” says Dr. Pripstein.

2. Don’t come to your appointments unprepared

Get the most out of your time—and your doc’s—by arriving at your appointment with a clear plan for what you want to discuss, says Dr. David Ross, an associate professor of family medicine at the University of Alberta in Edmonton. “It’s good to have patients think about their problems from when the issue began, then look at it chronologically to the present,” says Dr. Ross. Making a prioritized point-form list in advance helps ensure that you don’t forget anything or mix up the order of events, he says. Then, work with your doctor to address the most serious issues first.

3. Choose your family doc over the walk-in clinic whenever you can

Yes, a clinic is convenient, but what we gain in easy access, we lose in familiarity. “I think it’s really valuable if people can connect with a family physician who they’ll be able to see long term, rather than just looking for the quickest way to access care,” says Dr. Maurianne Reade, a physician with the Manitoulin Central Family Health Team in Mindemoya and M’Chigeeng First Nation, Ont. A family doctor will know your medical history and will keep it in mind when suggesting treatment—so, for example, if you’ve recently taken several courses of antibiotics for a UTI, your physician will likely look for a different course of action if you come in with another infection. According to the most recent statistics, about 4.5 million Canadians don’t have a regular family doctor. If that’s you, contact your provincial College of Physicians and Surgeons, or check to see if your region has an online registry (Ontario has Health Care Connect, while Quebec launched a web-based family doctor finder last year). “It’s important to know that we doctors are privileged to share in your stories and to help you through difficult times,” says Dr. Reade.

4. Share what’s happening in your life

There’s a reason your doctor wants to know where you’re working, if you’re dating and how the kids are—and it’s not just because she likes you. (Though she does, we’re sure.) Physicians need a picture of their patients’ lives beyond their specific health symptoms and conditions, especially when they’re first getting to know you, says Dr. Stephen Wetmore, the family medicine chair at the Schulich School of Medicine & Dentistry at Western University in London, Ont. “Doctors need to know these things to understand how your lifestyle and habits may be influencing your health,” he says. So when you’re talking about your exercise habits, your health history and whether you smoke, drink or use drugs, mention your employment status, family obligations and intimate relationships, too, says Dr. Wetmore.

5. Be a better googler

Doctors know you do it (hello, late-night web searches), but they would prefer you to ask about good sources of information, rather than going rogue online. They also want you to be honest about your fears if you’ve read something particularly upsetting. Physicians can’t address your concerns or point you in the right direction if they don’t know what your fingertips have been up to. “The thing we want our patients to do is ask us for the most reliable Canadian websites to go to as resources,” says Dr. Heather Waters, an assistant professor of family medicine at McMaster University in Hamilton.

6. Don’t think your symptoms are “no big deal”

If you’ve noticed you are having more headaches than usual or are sleeping more or are eating less, you might not think to tell your doctor—but you should. There’s no set of rules for determining which symptoms are worthy of investigation or discussion, says Dr. Wetmore, but make a note to mention anything that is new or has changed since your last appointment. “You should bring up things like sudden weight loss or fatigue that seems excessive,” he says. “It could be a sign of a larger problem, or the cause of a developing problem.” Evenif it doesn’t end up being serious, seeing your doctor will help ease any anxiety you might be feeling, and that’s worth the visit, too.

7. Talk about what you’re taking

Tell your physician about any herbal medications and alternative treatments you take, says Dr. Mel Borins, a University of Toronto associate professor and author of A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why. It’s important for patients to share what’s working for them and for doctors to be open-minded about therapies outside their own practice or traditions, he says. This is also a concern when it comes to conventional meds, especially if you’re pregnant; there are only 23 medications specifically approved for use during pregnancy— yes, out of every available drug—which can leave women feeling anxious about taking prescription or over-the-counter drugs when they’re expecting, says Dr. Robyn MacQuarrie, an obstetrician-gynecologist in Bridgewater, N.S. But don’t stop taking your meds as soon as your pregnancy test comes back positive. “It’s really important to talk to your doctor instead of stopping cold turkey,” says Dr. MacQuarrie. Physicians can help you determine the risks and benefits of using different drugs, and they can let you know when the effects of not taking a medication while pregnant may be worse than taking it— which is the case with some antidepressants.

8. Avoid diagnosing yourself

You know doctors don’t like it when you come in prepared with a diagnosis you’ve made thanks to the aforementioned Dr. Google. But do you know why? It’s not because they think you’re encroaching on their territory! Rather, they worry that a serious medical problem might get missed or you’ll cause yourself unnecessary anxiety over something not serious. That’s because not everyone has the most common symptoms of a particular condition. Plus, men, women and different ethnicities can have varying symptoms for the same problem. For instance, Dr. Reade’s community has a large proportion of people with diabetes, which can affect the warning signs of cardiac disease, a major killer in Canada. Instead of the usual pain or pressure on the left side of the chest or arm, men and women with diabetes may instead have spells of profuse sweating with weakness. And, of course, women who don’t have diabetes can have differing symptoms, too; sometimes, a heart attack can feel like acid reflux or come with sudden nausea, vomiting and lightheadedness. So always tell your physician if your symptoms are surprising or strange—like a headache that feels different than usual, for example. And if you’re worried about a specific diagnosis, be sure to bring that up, too.